Screening for Service
(Please note - this is a screening and NOT an application for benefits.)
What is the dollar amount of your past due rent/mortgage?
Please provide the following information for any other adult household member seeking services.
(Full Name, Social Security Number, Full Address, Telephone, Email)
Do you have any children?
Please list the name and ages of the children
Are your school-aged children currently enrolled in school?
Are YOU currently enrolled in school or vocational training?
List name(s) of school(s), school district, Day Care, Head Start, Early Head Start/CFRS
Do you or any adult member of your household have a criminal history or pending criminal charges?
Our emergency shelter is a low barrier program. That means having a criminal history does not prevent admission into the program however, failure to answer fully may result in discharge from the IHN Shelter Program.
Check all that apply.